| NPI | 1194717579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000257) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0601000761) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2018-01-26 |